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Awareness

As with many emotional and mental health issues, where so many keep their suffering a secret, it can be very hard to gain accurate figures. Another important consideration is that often even the friends and family of the person will be unaware of the self-harm, to such a degree is this secrecy.. What we do know though is that in the UK alone self-harm is responsible for over 150000 admissions to A&E a year, and this is only counting those who admit to their wounds being self inflicted. Research conducted anomalously through charities and support groups also indicate that only about 15% of people who self-harm will seek medical attention for their wounds, so this 150000 really can only be seen as the tip of the ice-berg.

People of all ages and from all backgrounds may at some time engage in self-harm, though it is most commonly seen among adolescents. The NICE report into self harm indicates that the average age changes of adolescence have been removed, but for many the issue will continue into adulthood. Self harm seems to be more common in females than in males overall, though in fact more boys than girls under the age of 10 are admitted to hospital due to self-harm. In adolescence, girls may be around two or four times likely than boys harm in different ways and may be more likely to cover it up as the result of an accident or a fight. Self harm also occurs in adults, and there is some evidence that adults who self harm are at greater risk of serious consequences such as suicide attempts or hospital admission.

One group of adults who seem particularly vulnerable to self harm are prisoners, over half of female prisoners on remand say that they have self-harmed at some point in their lives. This may be because some of the common triggers of self-harm are more common in those who are vulnerable to committing crimes than in the general population, the actual prison environment may also serve to cause self-harm as prisoners are likely to know others who self-harm, may be discouraged from openly expressing emotion, and are often unlikely to gain access to support for mental health issues.

Self-harm is generally defined as acting to deliberately injure yourself physically. The exact form of harm varies, some forms being invisible or don’t leave a wound, whereas others are visible, damaging the skin or other outer area. These visible forms (especially cutting) are seen as a more common form, but due to the secrecy held by many self-harmers regarding the activity and their reluctance to seek medical attention make it difficult to judge the real scale of self-harm.

Some people always harm using the same method, others use different methods based on what is available at the time or what will be easiest to hide. Some people who engage in self-harm do so only on specific parts of the body, others will vary in what area they harm, though many do say that they favour one area, failing to get the same degree of relief/comfort/pain/etc from other areas.

One very important thing to remember when discussing self-harm is the difference between acts with the intention of causing harm to the body and acts with the intention of ending ones life. In some ways these two actions could be seen as opposite to one another, with suicidal actions aiming to escape from life by ending it, whereas self-harm is an attempt to cope with life with the aim of continuing it. However, it is important to be aware that self-harm is often very closely linked to suicidal thoughts and attempts. Statistically those who self harm are many times more likely to attempt suicide than those who do not. Even those who are not suicidal may risk their life unintentionally if their harming becomes serious. Most teenagers say they harm in an attempt to express distress and escape difficult situations, but every year some lose their lives, even though this was not their aim.

This myth persists despite a wealth of studies showing that, although people who self-injure may be at a higher risk of suicide than others, they distinguish betwen acts of self-harm and attempted suicide. Many, if not most, self-injuring people who make a suicide attempt use means that are completely different to their preferred methods of self-inflicted violence.

People who self-injure are crazy and should be locked up.

Tracy Alderman, Ph.D., author of The Scarred Soul, addressed this:

“Fear can lead to dangerous overreactions. In dealing with clients who hurt themselves, you will probably feel fear. . . . Hospitalizing clients for self-inflicted violence is one such form of overreaction. Many therapists, because they do not possess an adequate understanding of SIV, will use extreme measures to assure (they think) their clients’ best interests. However, few people who self-injure need to be hospitalized or institutionalized. The vast majority of self-inflicted wounds are neither life threatening nor require medical treatment. Hospitalizing a client involuntarily for these issues can be damaging in several ways. Because SIV is closely related to feelings of lack of control and overwhelming emotional states, placing someone in a setting that by its nature evokes these feelings is very likely to make matters worse, and may lead to an incident of SIV. In addition, involuntary hospitalization often affects the therapeutic relationship in negative ways, eroding trust, communication, rapport, and honesty. Caution should be used when assessing a client’s level of threat to self or others. In most cases, SIV is not life threatening. . . . Because SIV is so misunderstood, clinicians often overreact and provide treatment that is contraindicated.

People who self-harm are just trying to get attention.

A wise friend once emailed me a list of attention-seeking behaviors: wearing nice clothing, smiling at people, saying “hi”, going to the check-out counter at a store, and so on. We all seek attention all the time; wanting attention is not bad or sick. If someone is in so much distress and feel so ignored that the only way they can think of to express their pain is by hurting his/her body, something is definitely wrong in their life and this isn’t the time to be making moral judgments about their behavior.
That said, most poeple who self-injure go to great lengths to hide their wounds and scars. Many consider their self-harm to be a deeply shameful secret and dread the consequences of discovery.

Self-inflicted violence is just an attempt to manipulate others.

Some people use self-inflicted injuries as an attempt to cause others to behave in certain ways, it’s true. Most don’t, though. If you feel as though someone is trying to manipulate you with SI, it may be more important to focus on what it is they want and how you can communicate about it while maintaining appropriate boundaries. Look for the deeper issues and work on those.

Only people with Borderline Personality Disorder self-harm.

Self-harm is a criterion for diagnosing BPD, but there are 8 other equally-important criteria. Not everyone with BPD self-harms, and not all people who self-harm have BPD (regardless of practitioners who automatically diagnose anyone who self-injures with BPD).

If the wounds aren’t “bad enough,” self-harm isn’t serious.

The severity of the self-inflicted wounds has very little to do with the level of emotional distress present. Different people have different methods of SI and different pain tolerances. The only way to figure out how much distress someone is in is to ask. Never assume; check it oput with the person.